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��et-Pn <br />City of Everett % <br />Engineering Department <br />Sewer Application and Permit <br />NO. 10433 DATE 2 <br />Service Address �-� �� _ Utility Account <br />• r <br />BillingAddres^ <br />City, State, Zip,-_ e : 'f /? <br />J <br />Owner (Mortgagor)--6 *! / F14 <br />Billing Name ;/I1i <br />Connection BY." X_ r •� <' <br />Address- r <br />Phone_ -4 r' <br />DESCRIPTION. <br />Lot ' <br />Block <br />Division or Addition,' <br />Remarks: n <br />SEE SKETCH ATTACHED <br />Connection Permit <br />Connection Fee_ ' '- <br />Jo <br />Total Fee eA-f' <br />r <br />Signed <br />emtom r <br />IN;PECTION <br />Sewer District_ <br />55 <br />Monthly Sewer Service Z., <br />Monthly Sewer Constr. <br />Approved By ' "('s`.�. <br />City Engineer <br />Issued <br />Connection By - <br />Inspection By <br />)ate Inspected � 3J 73 <br />